Pemphigus foliaceus induced by penicillamine.

Inhibition of Human Helper T Cell Function In Vitro by d-Penicillamine and CuSO4

“…Thus, the maximum concentration of copper employed (8 tkN4) was only half that found in normal serum and much less than that found in patients with rheumatoid arthritis who tend to have markedly elevated concentrations of both serum and synovial fluid copper (41,42,47,48). However, the vast majority of serum and synovial fluid copper does not occur in a free exchangeable form but, rather, as an integral part of the cuproprotein ceruloplasmin (41,42,(47)(48)(49) (1,9,24,25), levels of circulating immune complexes (26)(27)(28), and concenitrations of serum immunoglobulins (27)(28)(29)(30) (50)(51)(52), enhance (53), or have no effect (18, (52,56) and pemphigus foliaceus and vulgaris (57), that involve the development of autoantibodies. It is possible that in such patients suppressor rather than helper T cells are uniquely sensitive to the inhibitory action of Pen.…”

Pemphigus Provoked by <i>D</i>(-)Penicillamine

“…Pemphigus, or a pemphigus-like syndrome, is one of the most serious and perhaps the most common dermatological side effect of prolonged treatment with this drug. We found41 cases reported in the literature: Degoset al [1969]; Duperrat et al [1975]; Benveniste et al [1975] (5 cases); Hewitt et al [1975] (9 cases); Tan and Rowell [1976]; Davies and Holt [1976]; From and Frederiksen [1976]; Marsden et al [1976] (7 cases); Marsden et al [1977]; Stewart et al [1977]; Kristensen and Wadskov [1977]; Sparrow [1978]; Chinn et al [1978] (7 cases); Boehm and Holzmann [1978]; Thorvaldsen [1979] (2 cases); Chouvet et al [1980], We have evaluated these in an attempt to form an outline of aspects characterizing this type of iatrogenic pemphigus, even though the data were not always presented in full (table I). Although we believe that there may be several mechanisms by which Z)(-)penicillamine can induce pemphigus in certain subjects, who possibly are genetically predetermined, we wished to establish first whether Z)(-)penicillamine itself might interfere with epidermal intercellular cohesion without antibody mediation.…”

Does Clinical Research Help Pemphigus Patients? Precautions and Suggestions

“…the thiol drug hypothesis. It should be noted that for a drug like penicillamine, an induction rate of pemphigus foliaceus as high as 6-7% after 6 months of treatment has been proposed [4]. If that is the case, long-term cohort studies of patients treated with the drug could be feasible, looking at clinical and subclinical manifestations, and at potential pathomechanisms (molecular epidemiology).…”